. >> we are familiar with statistics that the u.s. spends significantly more percentage of gnp on health care than any other developed country. we hear that continuously. what i was surprised to hear at a recent conference was exactly the reverse is true when it comes to social support spending for lower income groups for seniors and people with disabilities or things like this. which raises the question in my mind would it be better for us to rebalance our spending in this direction to provide better quality by providing support services that allow people to stay in their homes functioning well instead of institutionalizing them which is very expensive. >> we need to figure out how to spend more sensibly and efficiently in health care no matter what else happens because it makes no sense. we know it can be done in a smarter way. the question about how and how much kind of support structure is a very large one. i will say that most, not all, most of the people who are now institutionalized in long-term care and other settings are ther